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刘志敏, 胡卓瑜, 江婕妤, 王雨莎, 胡齐, 彭清华, 陈向东.年龄相关性黄斑变性患者眼底图像分析与中医证型相关性研究[J].湖南中医药大学学报,2025,45(6):1076-1082[点击复制] |
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| 年龄相关性黄斑变性患者眼底图像分析与中医证型相关性研究 |
| 刘志敏,胡卓瑜,江婕妤,王雨莎,胡齐,彭清华,陈向东 |
| (湖南中医药大学第一附属医院, 湖南 长沙 410007;湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 目的 探讨年龄相关性黄斑变性（AMD）患者眼底图像特征与中医证型的相关性。方法 选取50例健康体检者设为健康组；200例AMD患者依据中医辨证分为脾虚湿困组（脾虚湿困证）、阴虚火旺组（阴虚火旺证）、痰瘀互结组（痰瘀互结证）、肝肾两虚组（肝肾两虚证），记录一般资料、证候信息。使用光学相干断层扫描（OCT）测量黄斑区脉络膜、视网膜厚度，眼底荧光素血管造影（FFA）及吲哚菁绿血管造影（IGGA）检测不同证型AMD患者的脉络膜新生血管（CNV）类型。结果 AMD组黄斑中心凹较健康组增厚（P＜0.01）。脾虚湿困组黄斑水肿病例多于肝肾两虚组（P＜0.05）。脾虚湿困组的水肿直径大于痰瘀互结组、肝肾两虚组（P＜0.01）。阴虚火旺组的渗出面积明显大于脾虚湿困组、痰瘀互结组、肝肾两虚组（P＜0.01）；肝肾两虚组的渗出面积小于痰瘀互结组（P＜0.05）。阴虚火旺组、痰瘀互结组的脉络膜厚度较脾虚湿困组与肝肾两虚组增厚（P＜0.05）。阴虚火旺组、痰瘀互结组视网膜厚度较脾虚湿困组与肝肾两虚组增厚（P＜0.05）。痰瘀互结组诊断出典型CNV的诊断率高于脾虚湿困组与肝肾两虚组（P＜0.05）；属于AMD典型CNV的患者以痰瘀互结证、阴虚火旺证为主，属于AMD隐匿型CNV的患者以痰瘀互结证、肝肾两虚证为主。结论 AMD患者中医辨证分型与眼底黄斑部改变、黄斑水肿、渗出面积、脉络膜、视网膜厚度及CNV具有一定相关性，OCT、FFA联合ICGA检测可为AMD的中医辨证提供客观的参考。 |
| 关键词: 年龄相关性黄斑变性 中医证型 光学相干断层扫描 眼底荧光素血管造影 眼底辨证 中医目诊 |
| DOI：10.3969/j.issn.1674-070X.2025.06.013 |
| 投稿时间：2024-09-30 |
| 基金项目:国家自然科学基金面上项目（82374525）；湖南省眼科疾病（中医）临床医学研究中心（2023SK4038）；中医药防治眼耳鼻喉疾病湖南省重点实验室开放基金项目（2018YZD10）；湖南省中医药管理局科研重点项目（C2023013）；湖南省教育厅科学研究项目（22C0184）。 |
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| Fundus image analysis in patients with age-related macular degeneration and its correlation with TCM patterns |
| LIU Zhimin, HU Zhuoyu, JIANG Jieyu, WANG Yusha, HU Qi, PENG Qinghua, CHEN Xiangdong |
| (The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China;Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Objective To investigate the correlation between fundus image characteristics and TCM patterns in patients with age-related macular degeneration (AMD).Methods Fifty healthy individuals were selected as the healthy control group; 200 AMD patients were divided into the spleen deficiency with dampness group (SDD pattern), yin deficiency leading to fire hyperactivity group (YDFH pattern), intertwined phlegm and blood stasis group (IPBS pattern), and deficiency of the liver and kidney group (DLK pattern) based on TCM pattern differentiation. General information and pattern data were recorded. Optical coherence tomography (OCT) was used to measure the choroidal and retinal thickness in the macular area, and fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were used to check the types of choroidal neovascularization (CNV) in AMD patients with different TCM patterns.Results The central foveal thickness of the AMD group was significantly greater than that of the healthy group (P<0.01). The incidence of macular edema was higher in the SDD group than that in the DLK group (P<0.05). The edema diameter in the SDD group was larger than that in the IPBS and DLK groups (P<0.01). The exudate area in the YDFH group was significantly larger than that in the SDD, IPBS, and DLK groups (P<0.01), while the exudation area in the DLK group was smaller than that in the IPBS group (P<0.05). Choroidal thickness in the YDFH and IPBS groups was greater than that in the SDD and DLK groups (P<0.05). Retinal thickness in the YDFH and IPBS groups was also greater than that of the SDD and DLK group (P<0.05). The IPBS group showed a higher diagnostic rate of classic CNV compared to the SDD and DLK groups (P<0.05). Patients with classic CNV were primarily classified as having IPBS and YDFH patterns, while those with occult CNV were mainly classified as having IPBS and DLK patterns.Conclusion There is a certain correlation between the TCM pattern differentiation in AMD patients and fundus macular area changes, macular edema, exudate area, choroidal and retinal thickness, and CNV types. OCT, FFA combined with ICGA test can provide an Objective reference for TCM pattern differentiation in AMD. |
| Key words: age-related macular degeneration TCM pattern optical coherence tomography fundus fluorescein angiography fundus pattern differentiation TCM eye diagnosis |
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